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Evidence summaries

Tranexamic Acid for Acute Traumatic Injury

Early treatment with tranexamic acid (HASH(0x2fd8d10)3 hours from injury) reduces mortality in bleeding trauma patients. For trauma patients admitted late after injury, tranexamic acid is less effective and could be harmful. Level of evidence: "A"

Tranexamic acid (with a loading dose of 1 g followed by infusion of 1 g over 8 h) early (HASH(0x2fd8d10)3 hours) after injury for adult trauma patients with or at risk of significant bleeding is recommended.

A Cochrane review [Abstract] 1 included 3 studies with a total of 20 528 subjects. Two studies compared tranexamic acid (TXA) with placebo and 1 study examined aprotinin. The pooled data show that antifibrinolytic drugs reduce the risk of death from any cause by 10% (RR 0.90, 95% CI 0.85 to 0.96; P=0.002). The majority (99%) of data came from the CRASH-2 trial including 20 211 adult trauma patients given TXA. The effect of TXA varied by time to treatment. Treatment within 1 hour of injury was associated with a 32% relative reduction in risk of death due to bleeding (RR 0.68, 95% CI 0.57 to 0.82) and treatment between 1 and 3 hours after injury was associated with a 21% reduction (RR 0.79, 95% CI 0.64 to 0.97). Treatment with TXA after 3 hours of injury was associated with a 44% relative increase in risk of death due to bleeding (RR 1.44, 95% CI 1.12 to 1.84). There was no evidence that the effect of TXA on death due to bleeding varied by the severity of haemorrhage, Glasgow coma score, or type of injury. The trial of aprotinin (n=77) provided no reliable data.

    References

    • Ker K, Roberts I, Shakur H et al. Antifibrinolytic drugs for acute traumatic injury. Cochrane Database Syst Rev 2015;(5):CD004896. [PubMed].

Primary/Secondary Keywords